three for a night

 It was a calm night shift until I expanded my portable army bed preparing for a good night retreat at midnight. Just after the setting up of my bed, I was called to see a patient came in for chest pain. The initial EKG12L had ruled out myocardial infarction and he was treated accordingly. The first round of pain killer combo however  did not resolve the pain and I had ordered an aortagram to rule out aortic dissection.

As I was stepping back into the call room, a police had brought in a patient complaining chest pain. The police claimed that he had run amok around the village and finally calm down after a chase. They had stressed that they did not used force to apprehend the patient. A friend that came in with them had however said that the police had forced him down from the roof. He had added that the patient was his construction co-worker who came from the east side. A relative had introduced the patient to him and had withheld that he had psychiatric disease.

The patient was tachycardic and normotensive. A immediate EKG12L was done and no sign of ischemic change. I had used to accept all the history input even if they were contradicted each other; I presumed that he had sustained trauma and most probably had an injury to his chest as his abdomen was flat and no tenderness was noted.

While preparing him for a CT with enhancement (he was 2^nd place in order awaiting the completion of the aortagram), another patient had presented to our ED. The patient was diagnosed as acute myocardial infarction and referred to a hospital up north for intervention as requested by the patient. On enroute, the patient had desaturated and the nursing personnel had decided to stop over at our hospital for further management.

Patient was irritable due to hypoxia and the initial bed-side sonography had revealed poor cardiac contractility and pulmonary edema. I had to intubate him prior to emergency percutaneous coronary intervention. His BP had crushed after the intubation as expected and I had to insert a central line and infuse dopamine to hold him long enough to the cath room.

It was 1+ hour later when I came back to see the trauma patient. He had looked paler and his abdomen had bloated. Apparently he had internal bleeding I had started another round of resuscitation in ED for this trauma patient. As the first patient, he was intubated and central line was inserted plus a load of blood product.

During the resuscitation for the 2 patients, their BP had reached a low of 30mmHg and with aggressive intervention, both of them had made it to the cath room and OR. The traumatic patient had proven to have a splenic rupture later by cat scan.

The other patient was a dud...after concluding three of them, I had managed to sunk into my bed at 5:45am...It was 20 minutes later when the swamp of morning patient rushed in....

It was a exciting night; with only 2 nurses and a aide, I was able to get the appropriate job done despite of the manpower issue. I just don't know how long can I keep myself in this shape to tackle similar scenario...

At my age, I am at the verge of going downhill, learning had become harder for me due to aging; however I thank the great one for his kindness to allow me to go through all this thrill and excitement...